How an ACA Repeal Would Harm Texans

With the Affordable Care Act (ACA) Open Enrollment deadline just one week away, it’s important to outline how important the landmark health law has been for Texans. Over 1.1 million Texans have selected plans in the health insurance Marketplace so far, with 27 percent of them being new to the Marketplace this year.

In our new fact sheet, we outline how dangerous a repeal of the ACA by Congress would be for Texas, especially without immediate replacement. Remember that in the first U.S. Senate debate and vote to set Congress on a repeal pathway, numerous Senators cautioned—including a number of Republican officials—that an ACA repeal without replacement is not an option. Agreeing on a replacement plan, they argued, will likely take time.

CPPP held a briefing at the Texas Capitol on January 24 to go over these threats to Texas. Watch a recording of the presentation here, and view the slides here.

Here are some of the challenges Texas could face if Congress repealed the ACA without giving Texans any other options:

Loss of Coverage, Collapse of Individual Marketplace. Over 900,000 Texans get sliding-scale discounts that cut their health insurance premiums by an average of 75 percent, and without those discounts most will drop coverage. Coverage for another900,000 insured unsubsidized Texans would also be in jeopardy. Insurance experts predict collapse of the individual (direct-purchase) Health Insurance Marketplace is likely with either a full repeal or “repeal and delay.” The American Academy of Actuaries has warned Congress that repealing major provisions of the ACA (even a repeal with a delay), or eliminating subsidies, could result in significant market disruption leading to millions of Americans losing health insurance. Economists from the conservative American Enterprise Institute have raised the same concerns.

Yearly or lifetime caps. If you have a serious injury or illness, you could hit a yearly or lifetime dollar cap, and have no more insurance coverage. Before the ACA, Texans with serious conditions like hemophilia, Crohn’s disease, cancers, or who needed organ transplant had coverage that stopped paying their bills at some point, leaving them scrambling for care, compromising their health and often causing financial ruin. About 5 million insured Texans had a lifetime limit on their insurance policy before the ACA.

Mental health coverage. Coverage of mental health needs or substance use disorder treatments could be dramatically reduced. Equal treatment for mental health and substance use disorder conditions—known as “mental health parity protections”—would be dramatically reduced with ACA repeal. The ACA extended mental health parity to cover more insured Texans, and repeal would mean millions of Texans would lose protection of equal access to mental health benefits in insurance.

Women could be unable to buy insurance that covers maternity, and could once again be charged more than men.Before the ACA ended gender discrimination in health coverage pricing, women in Texas were charged as much as 56 percent more than men for the same coverage (even with maternity benefits excluded). Before the ACA, women literally could not purchase coverage on the individual market that covered pregnancy—and not just after a women got pregnant. Insurers in Texas simply did not sell non-group policies that included maternity care.

Anne Dunkelberg oversees health care policy for CPPP. She focuses on policy and budget issues related to health care access and immigrants’ access to public benefits. She joined the Center in 1994 from the State Medicaid Director’s Office at the Texas Health and Human Services Commission. Anne is a founding member of the statewide Children’s Health Coverage Coalition (formerly the Texas CHIP Coalition) and the Cover Texas Now Coalition. She has been recognized by Families USA as an outstanding Consumer Health Advocate and by the LBJ School of Public Affairs Alumni Association as a Distinguished Public Servant. She was the primary author of the first edition of Texas Medicaid in Perspective (“the Pink Book”) and serves on the Texas Medicaid Managed Care Statewide advisory committee and the Texas Healthcare Transformation Waiver Executive Waiver Committee. Anne is a native Texan, and received her B.A. from the University of Texas at Austin, and her M.P.A. from the LBJ School of Public Affairs at the University of Texas at Austin.